Newcastle Alcohol Care and Treatment Service (Newcastle ACTS)
Newcastle Alcohol Care and Treatment Service (ACTS) consists of a mutltidisciplinary team that has been recruited with the aim of targetting those people with multiple admissions to hospital due to alcohol, as well as disadvantaged and socially excluded groups of people. The team includes mental health nurses, hospital nurses, assertive outreach posts and a Primary Care Trust Community Matron (Alcohol) and Specialist Nurse
A process to identify particular individuals was undertaken using hospital data in 2008. These people, often frequent reattenders are being actively targetted by the team. The model is a new type of health service with a focus on primary health care and extends support to a growing and increasingly complex population of clients with long term conditions and chronic ill health.
The aims of the project are to:
- expand the capability and capacity of current service provision by creating a multidisciplinary team that provides a service in the community such as community detoxification
- prevent unnecessary hospital admission due to alcohol-related behavioural problems
- ensure people with alcohol misuse issues are offered the appropriate intervention in a timely, safe, clinically and cost effective fashion
- ensure that socially excluded individuals have access to a range of support in relation to alcohol misuse and health and social care.
- expand capacity within the community setting to enable a greater resource for detoxification, whilst maintaining an appropriate level of provision for those individuals with complex needs
The objectives are to:
- achieve cost savings by developing community based services to divert away from inpatient services.
- provide integrated health and social care to clients with alcohol misuse problems
- produce clear pathways of care
- reduce hospital admissions and develop an appropriate alternative
- provide easier access to specialist support
- replace what was previously 10 day hospital detoxification with community detoxification. In 80-90% of cases, detoxification is without complications. Withdrawal at moderate levels of dependence can be handled safely and effectively by a Community Alcohol team.
- provide community access open clinics by April 2010.
- target complex clients who are traditionally difficult to engage with. Around 50-60% of alcohol dependent patients show a significant improvement over a twelve month period following treatment contact, whatever the intensity of treatment offered.
- retain flexibility to change and develop services which are attempting to meet a wide range of needs
Eleven and a half
1, 2, 3, 4, All
18 to 65
Background to project
Newcastle is in the top five local authorities for worst health and social deprivation indicators. Has one of the highest binge-drinking rates in the country.
Newcastle is also higher than the national average in terms of high risk and dependent drinkers and with high rates of alcohol-related ill health. In 2008 hospital admission data was analysed and showed that there were 1,411 admissions for 707 patients in 2008. Of these patients 239 were re-admitted. These admissions are approximately 70% higher than the national average.
There are also fewer alcohol treatment services available in Newcastle which has resulted in the longest waiting times for treatment nationally. It has been reported that only 1 in 102 for those in-need alcohol dependent people access treatment in the North East per annum.
On this basis along with statistics from the Department of Health there was a clear need to reduce alcohol-related hospital admissions in North Tyneside and Newcastle. Newcastle and North Tyneside Primary Care Trusts are Early Implementer Primary Care Trust's in the North East. Early Implementer status and funding was awarded in 2009.
At a strategic level, in 2008 the commissioning of Drug and Alcohol services, the Adult Commissioning Group and Drug and Alcohol Support Unit undertook a scoping exercise to look at practice nationally; and to better understand the service user and carer experience.
The desired features of an effective service were identified for Newcastle. The desired features of an effective service were identified at a strategic level as being:
- a treatment system that is flexible in meeting a wide range of needs
- the provision of brief interventions by GP's or other professionals in the community can reduce the prevalence of alcohol misuse
- that 50-60% of alcohol dependent patients show a significant improvement over a twelve month period following treatment contact whatever the intensity of treatment offered.
- that in 80-90% of cases, detoxification is without complications. Withdrawal at moderate levels of dependence can be handled safely and effectively by a GP or Community Alcohol Team and many cases can be treated without medication. However, inpatient detoxification remains the only safe option for a variety of life threatening and complex cases, and will need to be provided as part of an integrated treatment system
- that a small number of severely dependent patients respond preferentially to sustained and intensive help, although there is no clear evidence to establish what type of programmes are more effective
The exercise also examined the HubCAPP website and the original idea for a community matron was seen in one of the examples. It also became clear that services were under-developed in the community and the establishment of a community based alcohol team was one of the key recommendations. From the scoping exercise it was also proposed that a Primary Care Alcohol Service be established, with a community matron serving the GP clusters located around Newcastle.
The community matron will focus on the provision of a service to the most socially excluded people. These people often have a concurrent alcohol problem alongside a range of complex health and social care needs.
Operational planning for the service started in January 2009, with the team being appointed in August 2009. The service covers the four tier framework outlined in the Models of Care for Alcohol Misusers (MoCAM). It requires the enhancing of Tier 1 and 2 services (screening, advice and brief interventions) and expanding the Tier 3 work in the community undertaken by specialist alcohol services. The whole multidisciplinary team consists of two community based mental health nursing posts supporting the community detoxification service. Early Implementer funding awarded to Newcastle PCT has been used to fund these posts. There are also four and a half Assertive Outreach posts based in voluntary sector hostels in Newcastle, as well as the Community Matron post. Two Nurse Practitioner posts deal with physical needs and are based in the community. There are also two hospital based Specialist Nurse posts (Band 6). A senior Nursing post within the hospital also liaises closely with the Community Matron.
As part of the development and planning process for the project the team undertook an investigation of hospital data. Data was sought to help in the identification and targetting of complex clients who are difficult to engage with. It was recognised that many of the frequent attenders to hospitals were those whom the service wished to contact. It took six months in 2009 to overcome the data protection and confidentiality issues arising from using hospital data to target individuals.
The community matron model builds on the Kaiser Permanaent triangle. The triangle consists of three parts:
- Self care support and management: to help individuals and their carers to develop the knowledge, skills and confidence to care for themselves and their condition safely.
- Disease/Care Management: to provide people with complex needs with responsive, specialist services that use multi-disciplinary teams and specific protocols and pathways.
- Acute/Case Management: identify the most vulnerable people, those with highly complex needs and multiple long term conditions. Establish a case management approach with coordinated and joined up health and social care options.
The project requires the identification of people who are the most vulnerable with complex needs and often long term conditions. The project provides these people with a service made up of specialists within a multidisciplinary team, clear protocols and pathways. The project aims to help individuals and their carers to develop knowledge, skills and confidence to care for themselves.
The multiagency virtual team is co-ordinated and supported by a PCT hosted post, Treatment Effectiveness and Governance Manager (Drug and Alcohol) within a partnership agreement. This post as well as the Community Matron and PCT Specialist Nurse are permanently funded.
The role of the Treatment and Effectiveness and Governance Manager is:
- to establish the service, including citywide alcohol pathways to be launched (May 2010)
- to develop policies and protocols to support the work of the team
- to evaluate the service and establish the future planning based on needs assessment and first year activity
- act as Treatment theme lead within the Newcastle Alcohol Strategy
- to attract future funding to support the treatment theme within the alcohol strategy
Progress to date includes grant funding to support the development of:
- IBA training (Newcastle IBA Strategy) started September 2009
- IBA provision in Primary Care to start April 2010
- Peer Support for Alcohol to start April 2010
- Carer Support for Alcohol, started February 2010
- Alcohol and Domestic violence workers, April 2010
- Alcohol Data Analyst
- Alcohol Health Link Worker (Young People)- a post to support the alcohol agenda within schools and A&E
The role of the Community Matron is to:
- assess, provide clinical advice, manage risk for individuals with alcohol as their dominant issue
- support the multi-agency team and set standards, such as process for referrals, follow-up and after-care
- co-ordinate referrals and organise case conferences/multi-agency care planning meetings
- supervise staff and undertake training of staff
- liaise with non-statutory bodies
The Assertive Outreach team will :
- engage vulnerable clients with alcohol or substance misuse problems, targetting those who face social exclusion, providing peer support
- include workers who have themselves experienced social exclusion
- target a range of locations used by socially excluded groups
- focus on alcohol dependency and holistic approaches to maximise the engagement of the client group with services and take on an advocacy role
- develop and maintain good links with key services to improve client access
- help individuals to identify triggers that lead to crises and work with them to manage these triggers and improve overall health
The service commenced in January 2010. It will operate for one year with further funding being sought for subsequent years.
NHS North of Tyne
Cost descriptionFunding available to support this development comes from Annual Operational Plan resources which will enable growth in the community based teams and direct resources to those people who are categorised as using alcohol harmfully (potentially 14,266 people). This group of people will benefit from an increased community team and developed brief intervention programmes with the aim of reducing further harm from alcohol. More people will be able to access alcohol treatment by increasing this community based service.
- The Community Matron Model in Newcastle (ppt - 2.21Mb)
The development of a comprehensive community based team targetting repeat attenders, which is also intelligence led.
Monitoring and evaluation
Funding is available for this. It is not possible to cost the amount or provider at time of writing.
The discussions around obtaining agreement to use hospital data to target clients in the community were protracted.
Margaret Orange - Treatment Effectiveness and Governance Manager
firstname.lastname@example.org, 0191 219 5184